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General NPI Number Information
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NPI Number | 1750047312
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Entity Type | Individual
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Provider Name | RICHARD SMITH
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Gender | Male
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3562 E US HIGHWAY 30
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City | WARSAW
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State | IN
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Zip | 46580-6720
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Country | US
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Telephone | 574-372-4489
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Fax |
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Provider Business Mailing Address
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Address Line | 16965 HAMPTON DR
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City | GRANGER
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State | IN
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Zip | 46530-9177
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Country | US
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Telephone | 224-908-8128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401223648
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 99128465A
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License Number State | IN
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